Kunitaka Nagasawa

EFFECTS OF AGAR AND PECTIN ON GASTRIC EMPTYING AND POST‐PRANDIAL GLYCAEMIC PROFILES IN HEALTHY HUMAN VOLUNTEERS

1 Dietary fibre, such as pectin, delays gastric emptying and may enhance post‐prandial glucose tolerance. Agar, which is high in fibre content, is widely used in the traditional Japanese diet. Although long‐term diet therapy with agar decreases fasting plasma glucose levels in diabetes, knowledge is lacking about the acute effects of agar on gastric emptying and the post‐prandial glycaemic profiles. The present study was designed to investigate the acute effects of agar. 2 Ten healthy male volunteers were studied on three occasions with three different test meals (450 kcal/500 mL): (i) a fibre‐free meal; (ii) a meal with 2.0 g agar; or (iii) a meal with 5.2 g pectin. On each occasion, participants underwent a [13C]‐acetate breath test along with serial blood sampling. To quantify gastric emptying, the half [13CO2] excretion time () and the time for maximal [13CO2] excretion rate (tlag) were determined. The post‐prandial glycaemic response was expressed as an incremental change from the fasting value at each sampling time. Data were analysed using repeated‐measures analysis of variance (anova), followed by a post hoc paired Students t‐test with Bonferroni adjustment. 3 The time‐course for respiratory [13CO2] excretion differed significantly among the three test meals (P = 0.0004, anova). Compared with the control meal, [13CO2] excretion was significantly lower following consumption of the agar meal (between 40 and 105 min post‐prandially; P < 0.025, Students t‐test) and the pectin meal (between 40 and 180 min post‐prandially; P < 0.025, Students t‐test). Among the three meals, significant differences were found in (P = 0.002, anova) and tlag (P = 0.011, anova). Compared with the control meal, the agar and pectin meals exhibited a significantly prolonged (P = 0.007 and P < 0.0001, respectively, Students t‐test) and tlag (P = 0.006 and P = 0.002, respectively, Students t‐test). Neither the agar nor pectin meal affected the post‐prandial glucose profile. 4 In healthy adults, agar and pectin delay gastric emptying but have no impact on the post‐prandial glucose response.

Gastroduodenal Mucosal Injury in Patients Taking Low-Dose Aspirin and the Role of Gastric Mucoprotective Drugs: Possible Effect of Rebamipide

The present study was conducted to investigate the prevalence of mucosal injury in patients taking low-dose aspirin in Japan and examine the effect of gastric mucoprotective drugs on aspirin-related gastroduodenal toxicity. We selected 530 patients who had taken low-dose aspirin for 1 month or more after undergoing esophagogastroduodenoscopy from 2005 through 2006 at Teikyo University Hospital, Tokyo, Japan. Endoscopic records were retrospectively reviewed to determine the presence of massive bleeding and mucosal injury (ulcer or erosion). The influence of clinical factors, including co-administration of gastroprotective drugs, was also examined. Hemorrhage was observed in 25 patients (3.7%) and mucosal injury (36.2%) in 192 patients. The presence of Helicobacter pylori antibody was a significant risk factor associated with mucosal injury. Patients taking any gastroprotective drug showed a significantly lower rate of mucosal injury than those not taking these drugs. Patients taking rebamipide concomitantly with proton pump inhibitors or histamine 2 receptor antagonists had mucosal injury less frequently than those taking acid suppressants plus other mucoprotective drugs. In conclusion, these results show the possible gastroprotective effects of rebamipide, suggesting that it may be a good choice in aspirin users with gastroduodenal toxicity that is not suppressed by acid suppressants alone.